Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.

Action Points

Explain to interested patients that this study found that labeling a head injury a concussion potentially resulted in confusion about the severity of the injuries.

Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.

Among children admitted for a traumatic brain injury, those who were told they had a concussion were discharged significantly earlier (OR 1.49, 95% CI 1.15 to 1.94) and returned to school sooner (OR 2.42, 95% CI 1.56 to 3.73) than those who were not given the label, Carol DeMatteo, MSc, of McMaster University in Hamilton, Ontario, and colleagues reported in the February issue of Pediatrics.

The trends remained significant even after adjusting for the severity of the head injury and the presence of other injuries.

"We suggest that the [concussion] label itself conveys a message and also directs outcomes," the researchers wrote. "If we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term 'mild traumatic brain injury.'"

Disagreeing was Kenneth Perrine, PhD, a neuropsychologist at Hackensack University Medical Center in New Jersey.

"Granted, concussion is by definition a mild brain injury, but it's so transient that I think it would be a disservice both to the public and for research to continue to confuse mild traumatic brain injury with concussion," said Perrine, who was not involved in the study.

He said a true concussion is characterized by feeling like one is in a fog, fatigue, sensitivity to light and sound, headache, blurred vision or other visual disturbances, and feeling off balance.

A mild traumatic brain injury, on the other hand, has longer-lasting effects and is not usually accompanied by concussion symptoms. Retrograde amnesia, post-traumatic amnesia, and more severe memory loss would occur, he said.

"They are two distinct entities both from what we call it and from a prognostic standpoint," said Perrine, who is also consulting neuropsychologist for the New York Jets.

But, although the term concussion is used widely in clinical records and has garnered much attention in recent years because of head injuries to athletes at all levels of sports, an accepted definition does not exist, according to DeMatteo and her colleagues.

"Clinicians may use the concussion label because it is less alarming to parents than the term "mild brain injury," with the intent of implying that the injury is transient with no signiﬁcant long-term health consequences," they said.

Commenting on the study, Wendy Wright, MD, a neurologist at Emory University in Atlanta, said in an e-mail, "This study puts a spotlight on the issue that concussion is not always taken as seriously as it should be, partly because concussion encompasses a spectrum of disease."

She said parents, coaches, teammates, and the individual with the concussion may not believe the injury is serious because symptoms are transient.

That perception appears to be held by both clinicians and parents alike. DeMatteo and colleagues noted in the journal that during recruitment of the current study, both groups were heard saying, "He doesn't have a head injury, he has a concussion."

However, Wright said, "it must be noted that concussion means brain injury."

To explore how the term is used clinically, DeMatteo and colleagues analyzed the records of 434 children admitted to McMaster Children's Hospital with a diagnosis of acquired brain injury.

Of those determined to have a traumatic brain injury, 72.7% had a mild injury according to the Glasgow Coma Scale. Nearly one-third (32.4%) were said to have a concussion.

The concussion label was more likely to be given to children with a mild injury (P=0.03), but the association was weak, according to the researchers, and nearly one-quarter (24%) of children with moderate or severe scores were also said to have a concussion.

"This leads one to question the use of the term as being reflective of mild injury and again supports the existence of confusion about what a concussion really is and how the term should best be used in the care of children," the authors wrote.

"Our findings, both in the return-to-school data and the phenomenon we experienced during recruitment, suggest that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury," the researchers said.

They acknowledged some limitations of the study, including the fact that data from medical charts may have had missing information and a lack of control over the validity of measurements and that their use of only a single center might influence the results.

Further, they wrote, some measures, such as CT frequency, might be inflated because only children who were admitted to the hospital were included in the study.

The study was funded by a research grant from the Ontario Neurotrauma Foundation. The CanChild Center for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-Term Care.

The authors reported that they had no relevant financial disclosures to make.

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